How should I manage a patient with a confirmed extradural haematoma wh

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Management of a clinically stable patient with a confirmed extradural haematoma who requires monitoring:

Admit the patient to hospital under the care of a consultant-led team trained in managing head injuries and neurosurgical conditions to ensure competent assessment and observation .
Discuss the case with a neurosurgeon promptly, as extradural haematoma is a surgically significant abnormality on imaging and requires specialist input for ongoing care and potential intervention .
Perform and document neurological observations at minimum half-hourly intervals until the Glasgow Coma Scale (GCS) score is 15, including pupil size and reactivity, limb movements, respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation .
Once the patient has a GCS score of 15, reduce observation frequency to half-hourly for 2 hours, then hourly for 4 hours, then every 2 hours, reverting to more frequent observations if any deterioration occurs .
Use a standardised head injury proforma for documentation throughout the hospital stay to ensure consistent and thorough monitoring .
Be vigilant for any signs of neurological deterioration such as a drop in GCS, new focal neurological signs, seizures, or other complications, and escalate care immediately if these occur .
Consider the risk of hypopituitarism after head injury and investigate if symptoms or biochemical abnormalities (e.g., low sodium or blood pressure) develop during admission or follow-up .

How should I manage a patient with a confirmed extradural haematoma who is stable but requires monitoring?